Jeffrey C. Hellinger, M.D., from Stony Brook University Medical Center (Stonybrook, NY, USA), expanded on these techniques in a review article in the August 2010 early online edition of Radiologic Clinics of North America. He has developed CTA protocols that balance lower doses of radiation and clear diagnostic images when using CTA on infants and children. As principal author of the study, Dr. Hellinger detailed the appropriate and safe use of noninvasive CTA, in the framework of other potential cardiovascular imaging modalities, including radiography, echocardiography, vascular ultrasound, magnetic resonance imaging (MRI), and angiography (MRA), and invasive catheter angiography (CA).

"The use of any radiation in diagnostic methods carries a risk of causing cancer and of abnormal development, particularly in infants and children,” said Dr. Hellinger. "There is basically a medical necessity, if you are going to use radiation in your imaging, to use the lowest possible amount. I think it's a controversial topic as to how much radiation will lead to increased cancer risk over the lifetime of a patient. As physicians and imagers, with CT angiography, it is our goal to use the lowest possible radiation without compromising imaging quality. There is a balance between how low you can go with the technology and rendering a diagnosis. If the radiation dose is too low and the image is poor, you have wasted the radiation.”

Dr. Hellinger and coauthors presented in their article recommended low-dose pediatric CTA protocols and the necessary ancillary protocols to achieve high image quality, emphasizing that using complementary "gentle” cardiovascular CT scanning "can enhance the diagnosis and management of the pediatric patient with cardiovascular disease. Given the intrinsic dependencies upon radiation, utilizing this modality in pediatric patients mandates a commitment to dose reduction strategies, striving for ALARA [as low as reasonably achievable] in each cardiovascular CT examination.”

For each patient, Dr. Hellinger wrote, the risks, benefits, and alternatives to cardiovascular CT should be reviewed. "The pediatric CTA protocols are uniquely designed to maximize the table speed, image at the lowest possible voltage, and use the lowest possible weight-based tube current.”

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Stony Brook University Medical Center